Monday, April 30, 2012


A brand new project went live on the people fund it web site. Our idea is to create a very large chandelier using all the single earrings that linger in drawers after people have lost its matching pair. It will take over 5,000 earrings to complete the artwork. The project is a response to the feedback we have had from the staff at Manchester Central Hospital where we have been installing mini exhibitions in the Summerhouse (another artwork of ours). The chandelier will be dedicated to them and to the patients who view the work from the windows.

Over the last year or so Sharon and Lauren have been installing art in the Glass Summer House that they created for a commission in the Manchester Central Hospital Women’s Courtyard.

Sometimes funny, sometimes eccentric, sometimes plain pretty, the art has caused a stir and discussion. Staff and patients have watched us come and go. We have almost become part of the scenery.

So, in February we asked the hospital community what they thought of the exhibits. We listened, we heard and this artwork is our response to what people said. ‘We want colour, light, movement and to able to take part in the making’. This, then, is our gift to them; an antidote to the hospital experience.

Art in hospital is good for people. It is well researched and documented that it improves healing and recovery. Lauren and Sharon want to make sure that art is still made for the hospital environment so that is why we continue to put in these exhibitions.

The Chandelier of Lost Earrings will be our next installation and then we hope to continue to make more.

For all those of you familiar with the Invest to Save: Arts in Health research and the idea of Flow posited by Mihaly Csikszentmihalyi, you may be interested in this short film by film-maker David Bickerstaff and our friend and collegue Dr Victoria Tischler.This builds a very neat connection between what we in the arts reffer to as flow, but from a sporting perspective. Great work.


"I can't be the only one who's thinking that the present government are using the recession to push through policies that sew it all up for the privileged few. It's like they're kettling the rest of us in every way, closing us in and closing us down – shutting down libraries, restricting access to further education, hacking away at the NHS. I'm not a soapbox merchant but what defines a civilised society for me is that we look after the sick and the elderly, educate our kids, nourish and cherish the next generation and give them ideals that are worth sticking to."

Answer at the footer of next weeks BLOG.

Thanks as ever...C.P.
The Zone from David Bickerstaff on Vimeo.

Wednesday, April 25, 2012

Holding on to brain function through nutrition

By the year 2050, the number of people in the world over 80 years old will reach 370 million. About 50 percent of adults currently 85 and older have Alzheimer’s disease. The statistics are sobering and warn of a growing and serious epidemic. A high prevalence of Alzheimer’s disease, which is a debilitating and costly disease, can severely impact the population.

With this perspective, the American Society for Nutrition hosted a symposium on the nutritional prevention of cognitive decline on Wednesday at Experimental Biology in San Diego. At the event, speakers presented a comprehensive overview of epidemiological, animal, and clinical trials regarding the role of B vitamins, omega-3s, vitamin D, and caffeinated beverages such as coffee and tea in the prevention and treatment of cognitive impairment.

Martha Morris, Ph.D., an epidemiologist at Tufts University, discussed the relationship of folic acid, B12, and homocysteine to age-related cognitive decline, dementia, and Alzheimer’s disease. In summary, she said, the evidence suggests that sufficient B12 intake could protect against cognitive decline related to elevated levels of homocysteine. However, once B12 status was replete, there was no further protection.

The next speaker to follow was Lenore Arab, Ph.D., nutritional epidemiologist at University of California, Los Angeles, who presented on the effects of caffeinated beverages coffee and tea. The popular drinks, of which many in attendance wished for during the early morning talk, showed promise in helping to slow cognitive decline according to evidence from observational, animal, and clinical data.

Tommy Cederholm, M.D., Ph.D., of Uppsala Universitet, Sweden, discussed the large amount of epidemiological studies and human clinical trials exploring the role of omega-3s. The data suggest plenty of biological mechanisms such as reducing inflammation and protection against amyloid-beta protein deposits.

"Fish is good for your brain," Dr. Cederholm said, noting that intake may assist in early stages of cognitive impairment. However, he added, intake did not appear to assist in patients who already had Alzheimer's disease.

Lastly, Joshua Miller, Ph.D., a professor of pathology of University of California, Davis, discussed new research findings that vitamin D played a major role in the brain development and function. The epidemiological and animal studies suggest a positive effect in the prevention or treatment of cognitive impairment, he said, but randomized controlled trials in humans were lacking. Unlike other micronutrients, he added, vitamin D has a complexity because of seasonal variation, which suggests it's important to measure both in summer and in winter when performing studies.

How to fight "job-esity"

Workplace programs are an effective and worthwhile way for employers to help improve the health of their employees and reduce medical costs, scientists said Tuesday at Experimental Biology 2012 in San Diego at a session organized by the American Society for Nutrition. 

The medical expenses for employees who are obese are estimated at about 42 percent higher than for those with a healthy weight, according to the Centers for Disease Control and Prevention. Yet for the approximately 60 percent of Americans who are employed, it may be the workplace itself that is at the root of weight gain in the first place.

Shirley Beresford, Ph.D., professor of epidemiology of University of Washington, expressed optimism that workplace obesity programs could help reduce obesity based on a history of research. She explained that programs offered a way for employers to partner in intervention; however, she noted that the enthusiasm of employees for behavioral change may fall short.

The trouble with the workplace of Americans is that too often the mix of job insecurity, stress, sedentary behavior, and social eating present an "obesogenic environment," said Sai Krupa Das, Ph.D., assistant professor at the Friedman School of Nutrition Science and Policy, Tufts University.

Preliminary findings of the Tufts Healthy Weight Study offered a more promising picture for workplace intervention, Das said. The study resulted in substantial weight loss at six months that was sustained for at least a year.

Among the reasons why the intervention worked, Das said, are multiple components: encouraging physical activity combined with diet instead of either alone, behavioral counseling versus educational approaches, a high intensity versus a moderate intensity support group, and a structured maintenance protocol versus an unstructured self-directed program.

"These promising practices provide a broad framework for going forward," Das said. "We had a very robust intervention."

A workplace intervention program is likely to be cost effective for companies, according to economist Chad Meyerhoefer, Ph.D., an assistant professor of Lehigh University. In his presentation on cost-benefit projections for healthcare savings for employers, he gave the estimate that for every 5 pounds of weight loss the savings could range from $30 to $80 per person annually.  

William Dietz, Ph.D., director of the division of nutrition, physical, and obesity at the CDC, discussed a toolkit named LEAN Works! that was developed to promote worksite interventions. To set the example "at home," Dietz said, The toolkit was adopted on CDC campus. 

"We focused on changes on the environment," he said. For example, the campus featured music in stairwells to encourage their use, conducted a walkability audit, redesigned the campus to be more walkable, and installed lactation rooms. In addition, the CDC introduced fruit-and-vegetable vendors on campus so that employees could buy fresh produce once a week, made campuses smoke-free, and installed "lifestyle centers" (gyms).

Tuesday, April 24, 2012

The future of nutrition research

There is little question that nutrition provides the foundation of health and wellbeing and that research into better nutrition is central to enabling a population live healthier, more productive, and longer lives.

With this perspective in mind, the American Society for Nutrition assembled a working group of leading nutrition thought leaders to identify a list of nutritional research areas that required greater or further analysis and prioritization.

In a symposium entitled "The Future of Nutrition Research" on Tuesday at Experimental Biology 2012 (#EB2012), these thought leaders outlined what was generally agreed as the six areas of nutrition research that deserved attention.
The areas of the research comprised of the following:

  1. Understand variability in responses to diet and food—a broad area that includes research in epigenetics, proteomics, and metabolomics.
  2. Understand the nutritional impact on healthy growth, development, and reproduction
  3. The role of nutrition in health maintenance—with emphasis in determining how nutrition and fitness play into optimal health of the body (immune, cognitive, skeletal, and muscular function) over a lifespan.
  4. The role of nutrition in medical management—how nutritional factors influence disease and response to therapy.
  5. Nutrition-related behaviors—identifying how food choices can affect or become imprinted on the brain.
  6. Understanding the food supply environment—investigating the “farm to fork” influence on diet and physical activity and how biotech and nanotech can play a role.

The group also identified five tools in need of further development of which would be required to overcome barriers of nutrition research. The following tools, they said, would enhance the efficiency of research in each of the six areas listed above.
  1. Databases—for collection and assessment of food intake data.
  2. Biomarkers—needed to improve tracking and monitoring of food intake and response to treatments.
  3. Omics—biomarkers that provide data on how genes interact with nutrients, their metabolites, and proteins.
  4. Bioinformatics—application of computer science in biology and medicine.
  5. Cost-benefit analysis—tools to calculate and compare costs of interventions.

The multi-disciplinary working group included John Milner, of the National Cancer Institute, Dennis Bier of Children’s Nutrition Research Center, Houston, Catherine Ross of Penn State University, Z. Li of University of California, Los Angeles, David Klurfeld, of USDA, J Mein of Monsanto, and Pat Stover of Cornell University. Each of the individuals of the group presented about their respective areas.

A way forward: Meeting vitamin and mineral needs globally

Lindsay Allen

Efforts to curb or eliminate vitamin and mineral deficiencies globally have existed for almost a century, although there are now still as many questions if not more than ever before about what the next steps should be. There are seldom solutions that are simple to guide public policy internationally and there remain large challenges when it comes to making informed recommendations. 

Lindsay Allen, Ph.D., R.D, who is the 2012-2013 recipient of the E. V. McCollum International Lectureship in Nutrition, discussed a new way forward to improve the health of infants, children, and pregnant women internationally on April 22 at the McCollum Lecture organized by the American Society for Nutrition at Experimental Biology 2012 in San Diego. She currently serves as the Center Director of the USDA, ARS Western Human Nutrition Research Center. 

She discussed the challenges faced in global research and policy on micronutrient deficiencies as well as new methodologies on the horizon to improve research. She also called for the bringing together of more nutritional biology expertise—such that was present at the meeting—to assist in overcoming the difficulties in nutritional research such as ethical considerations when performing intervention studies in pregnant women and children.

In her presentation, Allen pointed out that modern technologies could assist in surmounting the unreasoned differences in recommendations of micronutrient intake such as that of iron or folic acid from one age to another either upwards or downwards. For example, there are measurements now available that can make use of samples of saliva, hair, or urine.

"I think that the methods we have been using like growth of babies, biochemical markers in blood are just not picking up changes in metabolism and immune function," she said. "You have these special tools to do genomics, metabolomics, and looking at gut microbiota. If we can draw in the expertise and ideas as well of people in the society and put all those different things in context of the studies we have ongoing, then we can really understand what’s happening when we give micronutrients to people."

She added, "The way forward is to bring that kind of expertise into the kind of rigorous field work that people are doing in developing countries.”

Another next step proposed by Allen is to encourage more basic nutritional science to be done in the United States of which could have an impact on health across the globe. For example, she said, there is more research needed in how micronutrients are absorbed in the diet and how micronutrients interact with each other. 

Moreover, Allen noted, there exists a greater need for research in methods development. For example, the development isotope analysis could bring new tools for use in international micronutrient deficiency research.

Former E.V. McCollum lecturer Andrew Prentice, Ph.D., who introduced and closed the lecture, called Allen’s presentation a "comprehensive tour de force" of micronutrient research and policy. He said Allen proposals presented a more agnostic approach to micronutrient research versus having various camps, such as the zinc promotional camp or iron or vitamin A. The key is to ask questions more intelligently.

"It would be so lovely if we could come up with very simple solutions and say we know that this is the policy process that we should undertake. It’s just a matter of implementing it," Prentice said. "In one or two cases that is true. Vitamin A supplementation of children has very clear-cut benefits. But with most of the other micronutrients we really don't know what to do, in whom to do it, at what levels to do it, and what would be the benefits."

Read more about Allen's talk in Nutrition Notes Daily, a publication circulated by the American Society for Nutrition.

Monday, April 23, 2012

Sugar Showdown: Science Responds to "Fructophobia"

The scientific community lashed out against "sugar is toxic" sensationalism on Sunday, April 22, identifying it as a distraction from more meaningful areas of research and debate on the causes of obesity and disease.

In a highly attended debate at Experimental Biology 2012 in San Diego sponsored by the Corn Refiners Association, scientists expressed clear frustration about the repeated assaults on sugar both in recentnews reports and in the scientific literature.

"You don't often see this at a meeting," said John White, Ph.D., of White Technical Research, to me after the event, referring to what he said was "the groundswell of researchers pushing back" against inflammatory remarks and overstatements.

The symposium organized by the American Society for Nutrition showcased both sides of the controversy surrounding the metabolic effects and health implications of sugar—fructose, sucrose, and high-fructose corn syrup—using latest available and emerging scientific findings.

As the first presenter, White presented data from the National Health and Nutrition Examination Surveys showing that no correlation existed between total fructose and the prevalence of obesity and that total added sugars and intake of sugar-sweetened beverages have declined for more than a decade.

"The support for fructose as a metabolic threat at current levels of intake is weak," White affirmed.

White also made the point that high-fructose corn syrup and sucrose are not different, suggesting the former might've been more appropriately called "medium-fructose corn syrup" because of its similarity to table sugar and other sugars.

Presenting a contrasting view, George Bray, M.D., chief division of clinical obesity and metabolism, showed data that soft drink consumption had increased from 1950 to 2000. Sugar-sweetened beverages, he argued, provide add-on calories that lead to weight gain, particularly from intra-abdominal fat.

In what promised to be a highly charged attack on sugar, characteristic of his appearance in media reports, Robert Lustig, M.D., began with a title slide displaying: "Fructose: alcohol without the 'buzz'". He argued that fructose metabolism was similar to that of ethanol's and that a "beer belly" was not far off from a "soda belly."

In his limited time, fast-talking Dr. Lustig quickly explained metabolic pathways and repeated remarks that fructose may be addicting to the brain like ethanol, based on animal research, and that fructose may be several times more likely than glucose to form advanced-glycation end products (a hallmark feature of uncontrolled diabetes).

Next to speak was cardiologist James Rippe, M.D., who presented a convincing argument that while fructose alone may have "qualitative differences," they were not "quantitative differences." He argued that research comparing pure fructose to pure glucose was not relevant to human nutrition. 

Sharing White's viewpoint, Dr. Rippe added that there were no metabolic differences between the sugars or fructose by itself—that is, there are no clinically meaningful effects on blood lipids at levels consumed by people normally, and no effects on uric acid or blood pressure.

He said the hot topic was an emotional issue creating a "perfect storm" for mistaken identity.

Dr. Rippe said afterward that Dr. Lustig's logic about fructose being uniquely responsible for disease was like going into "an alternate universe" that just did not stand up to scientific scrutiny. Yet it garners attention because of the public's habit of playing "the blame game" mixed with misconceptions about high-fructose corn syrup.

"People called him on it today," Rippe told me. By going to the media directly, he said, Dr. Lustig didn't have to have the same standards of proof that scientists usually must have. 

The last presenter was David Klurfeld, Ph.D., of the United States Department of Agriculture, who rounded out the debate again affirming that there was no evidence suggesting that sugar presented a unique metabolic danger.

"Is there a metabolic difference between sugars? Of course," Klurfeld said, "Is it biologically meaningful?" The answer was that it wasn't, according to the available evidence.

"The dose makes the poison," Klurfeld added. Should there be sugar regulation or taxation? There is insufficient data to justify any decision, Klurfeld said, quipping that whole milk would be next.

A question-and-answer period followed the debate giving a voice to disgruntled attendees who called Dr. Lustig out for suggesting that sugar was a metabolic danger. Dr. Lustig agreed that "everything can be toxic" at a dose, but sugar is abused and addictive.

One commenter (later identified as Richard Black, Ph.D., of Kraft Foods) responded saying that media should stop comparing sugar to cocaine by showing images where the brain lights up in the same areas. "The brain is supposed to light up in response to food," he said.

In an amusing but perhaps humbling moment for Dr. Lustig, he singled out the commenter asking if he had children. The commenter responded that he did. Dr. Lustig then asked him if as infants his children more easily liked sweet foods. The commenter said that, yes, of course they did because breast milk was sweet. Dr. Lustig replied that it was not. His reply caused an immediate reaction (notably, from mostly women) in the room who voiced in unison, "Yes, it is!"

John Sievenpiper, M.D., of St. Michael's Hospital told me after the event he was pleased that the speakers framed their arguments in a way that put the controversy in perspective. As shown in recent meta-analyses of which he co-authored, fructose demonstrated no significant effect on body weight or blood pressure in calorie-controlled trials. Fructose also demonstrated improvement of glycemic control at levels comparable to that obtained in fruit.

"It's hard to change people's minds," Dr. Sievenpiper said, stating concern that people would reduce intake of fruit in response to fears about the metabolic effects of fructose.

Don't miss this Storify story from folks on Twitter using the #sugarshowdown hashtag during the debate. Also, check out video blogger Emily Tomayko's recap on the ASN blog here.

Update 24-May-12: As a follow-up to this report, I've posted an interview with Dr. Sievenpiper here. Hopefully, it will help bring more clarity to the issues and answer several questions people have. If you wish to comment, please do so after reading that post. I've now closed comments on this blog post. 

Update 8-June-12: Check out videos (just published) of each of the talks. Here they are: White, Lustig, Bray, Rippe, and Klurfeld. Oh, and there is a video of the Q&A too. 

WOMEN ARE HEROES, Art in the Public Realm and a Free Conference

Thank you for the responses to the ‘Olympic’ themed Richard Creme competition. I’m pleased to say that the winers will be notified by email this week, and disconcertingly, a certain Lord Coe won one (hmmm, be interesting to see if he turns up!) Next weeks blog will be a Richard Creme special to coincide with the opening of his show at MMU.
For those of you who have commented on FCnK a big thank you, and its interesting to note a few things that link into it from the popular press and the streets of Liverpool this week.

Zoe Williams in her ‘saturday sketch’ further expands on Olympic histrionics and in particular takes the bell theme further. Here’s a snippet of her conversation with Loughborough resident, John Stevens. "Have you heard about the Olympic bell?" he asks. Nope. "So there's a giant bell, and the (local) Taylor Bell Foundry put in a tender to make it. But instead they gave it to a firm in London, who subcontracted it to a firm in the Netherlands. Now," he finishes darkly, "we all call it the Dutch bell". Oh yes – moaning, in an anti-authoritarian, not entirely serious but not exactly joking, way – that's another thing we're really good at.

The streets of Liverpool have been filled with teary eyed spectators, watching the progress of the Royal de Luxe produced, Sea Odyssey. An Olympic sized extravaganza, but polarizing opinions. Lynn Gardner in the Guardian commenting that, ‘...the result is inclusive theatre where young and old rub shoulders with the giants. We walk together in their footsteps, and we walk taller because they are with us.’ Chris Bradley in the online Liverpool Click is more scathing, noting the huge expense of the performance, suggesting the event cost around £2 million, and focusing on the Little Girl Giant urinating! The horror and outrage at the urinating has produced some blisteringly funny responses and in both the Gardner and Bradley articles, it's worth scrolling through the readers comments to get a balance of views, including the role and place of the local arts communities, comparisons to Notting Hill Carnival (or not) and of course, relieving yourself in public. 

I can see the thrill in this kind of event. People being together, technical skill, pathos etc - but I do think Gardner is perhaps over egging it a little suggesting ‘we walk taller because they are with us’ - how so, and what’s the long term impact? I’d like to know if anyone has been undertaking any research on the impact of this kind of street theatre, and once the carnival is gone and the streets have been scrubbed up and the Little Girl Giant, her dog and her uncle and packed off to the next city, what’s the legacy? Each year the firework shows just get bigger and I for one, love them (I think its in our nature), but just how big and spectacular can all these events get, and don’t they leave us unable to be satisfied by smaller moments and greedy for increasingly larger helpings - moving towards a super-morbid cultural obesity? 

This BLOG has shared a number of street artists over the years in an attempt to show that the work of people like Banksy is a bit more than a superficial tag. Recently images of spray-painted walls in Afghanistan, Russia and now Bahrain have taken this potency much, much further. French artist JR takes a different perspective on participatory art, that he explains as simply, ‘Raising questions...’ That said, he did win the TED 11 prize and his work really resonates when thinking about art in the public realm. I’m mindful of comments made by Mike White on the publication of the Derek Wanless report to the Treasury in 2004: Securing Good Health for the Whole Population. Mike drew from this report and other work he’d been scrutinizing, that it is women's health and particularly women's education, that has the greatest impact on society. More than that - female literacy rates are the most significant indicator of mortality.

So, Women are Heroes is a book and a film by JR - but more than that, its an artist illuminating something of the world beyond the narrow confines of individual experience.

Here is an interesting quote from an article reviewing the book. When one onlooker in Monrovia didn't know what an art exhibition was, another person explained it thus: "You have been here for a moment looking at the portraits, asking questions, trying to understand. During that time, you haven't thought about what you will eat tomorrow. This is art."

Панк-молебен Богородица, 
Путина прогони PUSSY RIOT в храме 
Discerning readers may be picking up on how art in the public realm may have an impact that reachers wider than narrow sensationalism and potentially has political implications, that in turn, have clear implications on well-being. Since February three women from the punk-rock collective, Pussy Riot have been held in detention in Moscow, for performing a protest song against president elect Putin and what they see as the Russian Orthodox Church collaborating in politics. 13 more people were arrested over the weekend for demonstrating outside the Moscow courthouse, where the band members face up to seven years in jail.

“Five masked members of Pussy Riot performed a protest song entitled “Holy Shit” at the altar of the Christ the Savior Cathedral in downtown Moscow on February 21. The lyrics included lines such as “Holy Mother, Blessed Virgin, chase Putin out!”
Pussy Riot said the performance was a response to Orthodox Church head Patriarch Kirill’s backing of President-elect Vladimir Putin in the run-up to his landslide March 4 election victory. The patriarch called the 12 years of Putin's rule a "miracle of God" in a televised meeting. Putin’s press secretary said the president-elect reacted “negatively” when told of Pussy Riot’s protest.”

10 + 11 May 2012
Music in Healthcare Settings Seminar
Royal Northern College of Music, Manchester

RNCM Music for Health is pleased to invite people working in the cultural and health sectors to attend a FREE 2-day seminar about music in healthcare.

The seminar will
1. present the experience and learning from the EC funded ‘Music in Healthcare Settings: Training Trainers project’ (Leonardo Transfer of Innovation) at a local, national and European level;
2. highlight the importance of working in partnerships across the cultural and health sectors;
3. compare and discuss policy frameworks in the UK and France;
4. present case studies of musical interactions in healthcare settings and outline the training offered by RNCM, including the Medical Notes project funded by Youth Music;
5. present evaluation and research findings from the RNCM Music for Health programme.

The seminar is FREE, but booking is essential as places are limited.
To reserve your place for either one or both days, please fill in the booking form attached and return by email to no later than 1 May 2012.

For info on the project and seminars in our partner countries, go to

Women Make Music Opens for Applications (UK)

The Performing Right Society (PRS) has announced that its Women Make Music grant scheme is now open for applications.  The second year of Women Make Music comes after a successful pilot programme in 2011.  Through the programme, financial support of up to £5000 is available to women musicians; and new music in any genre is welcome, from classical, jazz and experimental, to urban, electronica and pop. 

The aims of Women Make Music are:
  • Break down assumptions and stereotypes within the music industry by encouraging role models for future generations
  • Raise awareness of the gender gap and to ensure that women are aware that support for new music is available to them
  • Increase the profile of women who are creating new music in the UK
  • Stimulate new collaborations between organisations and female music creators

There are two funding rounds in 2012 and the application deadlines are the 17th May 2012 and the 10th October 2012. For information visit: 
As ever, thanks for looking...C.P

Hunger is your best friend: It makes natural foods taste delicious and promotes optimal nutrient partitioning

One of the biggest problems with modern diets rich in industrial foods is that they promote unnatural hunger patterns. For example, hunger can be caused by hypoglycemic dips, coupled with force-storage of fat in adipocytes, after meals rich in refined carbohydrates. This is a double-edged post-meal pattern that is induced by, among other things, abnormally elevated insulin levels. The resulting hunger is a rather unnatural type of hunger.

By the way, I often read here and there, mostly in blogs, that “insulin suppresses hunger”. I frankly don’t know where this idea comes from. What actually happens is that insulin is co-secreted with a number of other hormones. One of those, like insulin also secreted by the beta-cells in the pancreas, is amylin – a powerful appetite suppressor. Amylin deficiency leads to hunger even after a large carbohydrate-rich meal, when insulin levels are elevated.

Abnormally high insulin levels – like those after a “healthy” breakfast of carbohydrate-rich cereals, pancakes etc. – lead to abnormal blood glucose dips soon after the meal. What I am talking about here is a fall in glucose levels that is considerable, and that also happens very fast – illustrated by the ratio between the lengths of the vertical and horizontal black lines on the figure below, from a previous post ().

Those hypoglycemic dips induce hunger, because the hormonal changes necessary to apply a break to the fall in glucose levels (which left unchecked would lead to death) leave us with a hormonal mix that ends up stimulating hunger, in an unnatural way. At the bottom of those dips, insulin levels are much lower than before. I am not talking about diabetics here. I am talking about normoglycemic folks, like the ones whose glucose levels are show on the figure above.

On a diet primarily of natural foods, or foods that are not heavily modified from their natural state, hunger patterns tend to be better synchronized with nutrient deficiencies. This is one of the main advantages of a natural foods diet. By nutrients, I do not mean only micronutrients such as vitamins and minerals, but also macronutrients such as amino and fatty acids.

On a natural diet, nutrient deficiencies should happen regularly. Our bodies are designed for sporadic nutrient intake, remaining most of the time in the fasted state. Human beings are unique in that they have very large brains in proportion to their overall body size, brains that run primarily on glucose – the average person’s brain consumes about 5 g/h of glucose. This latter characteristic makes it very difficult to extrapolate diet-based results based on other species to humans.

As hunger becomes better synchronized with nutrient deficiencies, it should promote optimal nutrient partitioning. This means that, among other things: (a) you should periodically feel hungry for different types of food, depending on your nutrient needs at that point in time; (b) if you do weight training, and fell hungry, some muscle gain should follow; and (c) if you let hunger drive food consumption, on a diet of predominantly natural foods, body fat levels should remain relatively low.

In this sense, hunger becomes your friend – and the best spice!

Sunday, April 22, 2012

Beyond calories in, calories out -- look to the Amish

What is wrong with "eat less, move more"? Most of us are familiar with this mantra as weight-loss advice. However, a new consensus statement from the American Society for Nutrition (ASN) and the International Life Sciences Institute (ILSI) contends that this energy-in-energy-out framework isn't really so simple.

The problem lies in that consuming fewer calories and burning more through physical activity doesn’t always translate well to weight management. That is not to say that the framework of energy balance—negative energy balance for weight loss; positive energy balance for weight—is wrong. At some level, it’s right; however, several factors come into the equation.

During a Saturday morning session of Experimental Biology (#EB2012) in San Diego, Calif., researchers discussed the topic of this complexity and promoting a new paradigm on energy balance.

Energy balance is not just about addition of diet and exercise; each affects the other, so that changing one changes the others, explained Jim Hill, professor of pediatrics and medicine at the University of Colorado School of Medicine, Denver, and new recipient of the W.O. Atwater Lectureship awarded by the American Society for Nutrition.

What must be appreciated is the body's system of active regulation, he said.

"It's not just a little man in your head that," he said, adding that the body may rely on a 'set point' or 'settling point' type of system that attempts to balance energy, energy stores, glucose, glycogen, fat stores, and temperature.

"You might argue that up to the 1970s, the system worked pretty well," Hill said. "This whole system is based on inherited factors. If you look at what’s really changed since the 70s, it's really the environmental factors. We don't have to hunt and kill our food anymore. We go to the supermarket and fill our carts. We also sit in some form of fashion every day."

Obesity, a problem of overwhelmed "active regulation"

Most of these environmental influences are designed to increase energy intake. It becomes more difficult to avoid overeating and underactivity. These influences, summed up, overwhelm active regulation and the body’s energy balance system. Then the body's physiology adjusts.

Are there things in the food supply that cause to eat more? Are they influences that affect our brains and nervous system? Hill said that however they may affect us, it is still through energy balance. He said he "laughs every time" he sees studies questioning whether the rise of obesity epidemic is related to energy intake or expenditure.

"Diet and physical activity interact," he said. "Please don't ask if it's diet or physical activity. The answer is 'yes'."

What wrong with diets? No matter which diet, Hill said, the results are always the same: Body weight may increase, may not change, or may decrease. The inconsistent outcomes may be because of poor compliance, physical activity, metabolic rate differences, or food intake adjustments. Eventually, what goes wrong is that environment affects behavior so strongly that over time that people are gaining a little weight. They don’t gain a lot, but they gain about a pound or two a year with some push back from their active regulation systems.

One way to combat the obesity epidemic is by encouraging an environment more like that of a half a century ago, Hill said. How the old order Amish live today is a good example.

"The Amish walk 18 thousand steps a day. They don’t have spandex or a gym membership. That explains about 400 to 600 calories a day. A typical person in the U.S. walks only five to six thousand steps a day," Hill said.

Hill suggests preventing weight gain with small steps—or, more specifically, 2 thousand steps daily.

"We have a poor ability to maintain weight loss, but we have a better ability to prevent weight loss,” he said. “This is why we started a movement to move. Two-thousand steps a day is not going to create weight loss, but might prevent weight gain."

What role can small changes play in an environment where we need bigger systemic changes? Hill argues that it will "set the table" for bigger change. Another factor may be that it may help to improve performance or "reset" active regulation.

"Our biology works best at high levels of physical activity. Obesity is in the 'unregulated zone.' When physical activity increases, you enter 'regulated zone'. Physical activity may help the 'regulatory system' work better."

Stealth health

Until bigger changes can be created in the environment, Hill is a fan of "stealth health" strategies for reducing obesity. That is, finding ways of encouraging better energy in, energy out balance without the public noticing.

For example, Hill explains, at Disney parks and at Starbucks, drinks are now made with low-fat milk. Does anyone notice the difference? What about portion sizes? Would anyone notice a 5 percent reduction at restaurants?

Another idea Hill proposed was that of regulation of school drop offs—so that they would be 500 steps away from the school. Would it be so far that the children would notice a difference?

The implementation of these "stealth health" strategies would increase physical activity and reduce overeating. Combined with teaching children energy balance skills, it could reduce childhood and overall obesity.

What also may be important is to combine both diet and physical activity guidelines for society? But how can this be achieved when studies show that energy balance is such a dynamic versus static process?

Learn more about the questions raised about energy balance at Experimental Biology from the American Society for Nutrition’s cover page story in Nutrition Notes Daily

Can carotenoids in the brain protect against Alzheimer’s?

Carotenoids are thought to protect against Alzheimer's disease because of their antioxidant properties and their accumulation in the brain. However, a new study from Tufts University is putting the theory into question.

More than a century has passed since the German physician Dr. Alois Alzheimer first presented evidence on the case of Auguste Deter, who at only 51 suffered from severe memory loss and other psychological changes. At autopsy, Dr. Alzheimer found his patient had severe shrinkage and abnormal deposits of the nerve cells.

"That was in 1906," said nutritionist Annie Roe, a USDA researcher at Tufts University, who presented her laboratory's findings on April 21 at Experimental Biology 2012 in San Diego. "There's still disparity among scientists as to the etiology of this rapidly growing disease as we now know as Alzheimer's disease."

Currently, in the United States there are 5.3 million people with Alzheimer's disease. Unless new methods of intervention are available, however, the number is expected to reach 16 million by 2050. While the cause of the disease is not known, the deposits that Dr. Alzheimer first noted are now known to be amyloid-beta peptide deposits.

These deposits, or plaques, are a "hallmark diagnostic feature" of Alzheimer’s disease. Within the same region amyloid-beta plaques are found, increased concentrations of oxidized proteins, lipids DNA are also observed. It’s not yet clear whether or not that these products of oxidative stress caused the amyloid-beta plaque build-up or vice versa.

However, Roe said, it is clear that oxidative damage promotes neurotoxicity and is involved in cognitive impairment. Epidemiological studies have found that a higher dietary intake of carotenoids from fruits and vegetables are associated with reduced risk of age-related chronic diseases including Alzheimer’s disease. Other studies measuring the concentration of carotenoids in plasma have found an inverse relationship with chronic diseases.

Fruits and vegetables are the major sources of carotenoids in the diet, the most common of which are beta-carotene and beta-cryptoxanthin—two provitamin-A carotenoids. There is also lycopene, lutein, and zeaxanthin, which have no vitamin A activity. There are several biological mechanisms being explored for carotenoids' potential protection to the brain.

However, Roe explained that her laboratory research focuses on the role of antioxidants and their relationship to Alzheimer's disease, clinically determined by increased cognitive impairment. Since Alzheimer's affects brain tissue, the researchers' study purpose was to determine the concentration and magnitude of lipid peroxidation in brains diagnosed with Alzheimer’s disease compared with age-matched controls.

The Tufts laboratory received brain tissue samples from the National Institute for Child Health and Human Development (NICHD) Brain and Tissue Bank for Developmental Disorders. The samples were obtained from 15 individuals with Alzheimer’s disease and half with no known dementia. The samples were from subjects in their late 70s or early 80s, most of whom were Caucasians. The samples were of four different brain regions: occipital cortex, frontal cortex, hippocampus, and auditory cortex. To assess lipid peroxidation, the researchers extracted malondialdehyde (MDA)—a marker of oxidative damage—through HPLC.

When looking at relative distribution of major carotenoids between Alzheimer’s disease and controls, the study found the provitamin A carotenoids contributed to a significantly higher percentage of total carotenoids in the Alzheimer’s brains compared to the controls. Non-provitamin-A carotenoids contributed to higher concentration in control brains compared to Alzheimer’s disease brains, but there was no statistically significant difference.

In addition, Roe said, the absolute concentrations of provitamin-A carotenoids were higher in Alzheimer’s diseased samples versus control samples. There was no difference in absolute concentrations of lutein, zeaxanthin, or lycopene. There was also no significant difference between malondialdehyde concentrations and carotenoid concentrations.

Consistent with findings of increased pro-vitamin A carotenoids, retinol (vitamin A) concentration was significantly greater in the Alzheimer’s disease brains. However, when the study looked at malondialdehyde concentrations, there was not a significant difference between the two groups.

The findings "were interesting but unexpected," Roe said, adding that when she looked at each region separately, she saw the same pattern in the hippocampus, a region that is highly vulnerable to the disease.

Since prior research has shown both in cell culture and in clinical studies that vitamin A can have a positive effect on beta-amyloid aggregation, it is possible that caregivers or physicians confounded results. For example, they may have encouraged their patients after diagnosis to consume more fruits and vegetables. It may be that carotenoids are beneficial to the brain, but simply not after the disease has set in. Roe suggests future studies should include dietary intake assessments and target people with earlier stages of dementia.

"This is just a snapshot view of a small group of people at the end of life, so we can't infer any type of causation and certainly should not interpret the results to mean that vitamin A is bad for the brain," Roe said.

The study's results contradicted that of previous research, also presented at the conference by Neal Craft of Craft Technologies, which found an age-related decline of carotenoids in elderly brains that suggested that diminishing levels may be associated with Alzheimer's disease.

Friday, April 20, 2012

Could how much and often people eat depend on their genes?

Thanks to the Human Genome Project, we humans now know that we are all really very much the same at the level of our DNA. Our genomes are 99.9 percent identical, leaving really only 0.1 percent responsible for giving each of us what we would consider our differences or unique qualities. It's within this 0.1 percent that may also explain why some of us may be more likely to be overweight, obese, or susceptible to a disease such as type 2 diabetes.

One of the most promising developments in nutrition research are the insights provided by studies on how dietary components interact with genes. The knowledge gleaned could one day be used for reducing risk of disease and staying healthier, longer. This area of research is nutritional genomics, or nutrigenomics for short. Eventually understanding more about nutrigenomics could lead to our ability to better personalize our diet plans and make better food choices based on our genetic code.

Interestingly, however, new research suggests that it may be genes themselves that are guiding how much we eat as well as our food choices. The Genetic Subgroup of Look AHEAD and the Look AHEAD Research Group have recently reported findings in the American Journal of Clinical Nutrition that obesity-related gene sequences (loci) may affect how overweight or obese with type 2 diabetes consume food.

Their study found that a group of obesity-risk alleles, FTO, significantly predicted eating and snacking more frequently. Another, BDNF, was significantly associated with eating more servings of protein-rich dairy, meat, eggs, nuts and beans. SH2B1 was associated with eating more servings of dairy (perhaps due to changes in leptin signaling). On the other hand, TNN13K, was significantly associated with lower percent of protein energy in the diet and higher intake of fats, oils, and sweets energy.  

Obvious limitations to these genetic associations are that -- although there were 2,075 participants in the study from an ethnically diverse sample including men and women -- the conclusions were based a cohort of only overweight or obese people with type 2 diabetes. Additionally, the study measured dietary intake through food frequency questionnaires, which are often limited in accuracy because of over- or under-reporting. Lastly, other factors like physical activity would probably affect any of the correlations.

Despite limitations, the researchers report the results suggest that markers within FTO, BDNF, TNN13K, and SH2B1 could be used to predict a predisposition to overweight or obesity perhaps because of the way the genes may affect eating patterns and frequency.

And, if replicated, the researchers report, could lead to new discoveries on mechanisms by which these genes affect eating.  


McCaffery JM, Papandonatos GD, Peter I, Huggins GS, Raynor HA, Delahanty LM, Cheskin LJ, Balasubramanyam A, Wagenknecht LE, Wing RR. Obesity susceptibility loci and dietary intake in the Look AHEAD Trial. American Journal of Clinical Nutrition. doi: 10.3945/ajcn.111.026955.

Thursday, April 19, 2012

New and old tools of science communications

Sci-comm thrives on social media. 
"Writing is thinking on paper" is one of the many beautiful phrases by William Zinsser, author of On Writing Well. Only, if Zinsser had put those words down more than three decades later, he might have added that writing is also thinking on blogs, Twitter, Facebook, and Google+.

As I prepare to head off to San Diego for Experimental Biology (#EB2012)—where I’ll be blogging about The American Society for Nutrition's meeting—I’ve been thinking a good deal about Zinsser’s phrase and about Mary Canady's (@comprendia) call for those attending #EB2012Tweetup to share their new media science communications success stories. My own story begins with me simply blogging and tweeting as a way to think and as a way to remember what it was that I thought

I learned early on that I was never very good at thinking about new information clearly or remembering my thoughts later—unless I wrote my thoughts down. So, I originally began to write (as I'm sure many writers do) as simply a way to make sense of the world around me. Writing then became part of my education and eventually led to a profession in science writing (see "About David").

Why do I now blog and tweet about health? At first, I simply found blogging was a good way to take notes on new tidbits I was learning about as part of my master’s degree in human nutrition. Later, when I started attending science conferences, I discovered tweeting combined with blogging became a way to engage and network with the smart, like-minded people around me. I found that these new social media tools represented excellent ways to encourage discussion and debate about science. And, especially as it comes to health-related science, healthy skepticism is key.

 For these reasons, I often encourage others to blog and tweet—scientists and non-scientists alike—about topics such as food, nutrition, and medicine. Social media tools are the perfect avenues by which science can thrive. After all, science itself is all about collecting data, sharing information, and establishing consensus.

 It's also the engagement with science-minded people, the discussion, and, sometimes, the argument that encourages me to continue to blog. Most of all, it's the collective thinking. Thinking, after all, will always be a part of writing however or wherever it is done.

As Zinsser himself points out in the introduction of his 30-year anniversary edition of his classic, "I don't know what still newer marvels will make writing twice as easy in the next 30 years. But I do know they won’t make writing twice as good. That will still require plain old hard thinking… and the plain old tools of the English language."

Monday, April 16, 2012

The Richard Creme exhibition will be open to the public at the Link Gallery at MMU from 2nd May until 11th May. You can find out more about this show by clicking on the image by international fashion photographer, Richard Burbridge below. More details of the show will be announced next week.

Four members of the North West Arts and Health Network have the opportunity to attend a private party on 1st May with Richard and his special guests...! This is a very, very special event and the nearest the network gets to exclusivity. To have your name entered into the prize draw, simply think about your answer and email it to before 2:00 on 25th April.
1. Which multinational and Olympic Partner do you associate with image 1

2. Which multinational and Olympic Partner do you associate with image 2

3. Which multinational and Olympic Partner do you associate with image 3


Originally set up as an informal regional network for people living and working in the North West Region, The North West Arts and Health Network has members in a range of countries including amongst others Afghanistan, Canada, India, Lithuania, Mexico and Sweden. Once in a while, its good to share some of the work that’s happening in other countries. One; because its just good to learn more about what we’re all up to and two; because we can be a little myopic in the UK. So, please feel free to get in touch if you are outside the UK and want to share your work, and once in a while we can share. Today, I’d like to introduce some of the work of Debasmita Dasgupta who creates graphic novels for children, and here is her ‘mini fish tale’ published as a blog, which she’s also developed as a free android app for children, with the not-for-profit grassroots organisation; the Bakul Foundation in India. Click on the photo to go to the story-blog.

This work has also been recently developed this into a free android app for children
A few years ago I had the pleasure of meeting Molly Carlile at the First Art of Good Health and Wellbeing, International Conference in Australia. Molly describes herself as a Death Talker: someone who through her professional nursing career, has expended her perspectives around how we live and die. Molly Carlile lives her motto ‘The more we talk, the less we fear’, by encouraging informed conversations about death and grief in order to demystify and de-stigmatise these experiences.  Molly has initiated a number of projects to engage and empower communities to deal more openly with terminal illness. Particularly interested in how the arts can play a part in peoples dying, she is a strong and charismatic voice in rethinking, how we approach are own, and others death. I quote:

“We don’t talk about death because we think of ourselves as immortal. We have faith that no matter what is wrong with us, there will be a treatment that will fix it. We tell our kids that death is something that happens to old people. And so we live in a bubble of denial, hoping that if we don’t think or talk about death, we can avoid it. So when death happens we are poorly informed, badly prepared and often suffer our grief in isolation because we have no one to talk to about how we are feeling.

The time has come for us to face death, to inform ourselves and to build our ability to show compassion to the people around us who suffer in silence and isolation.”
I recently nominated Molly for the 2012 International Journal of Palliative Nursing Awards, Educator of the Year Award. I am thrilled to say - she won it! Well done Molly - and justly deserved. Click on her photo above to see her website.
I’ve been trying not to join the ‘viral’ world, but after Claire Ford shared her work in the USA with us at the last networking event, it would be silly not to share this video that has had almost 5,000,000 hits since we last shared it!!! You can find out lots more about this work and more at  

Here’s another story about he Tricycle Theatre, Improvisation and Dementia. Just click on the photo below.

And finally on the dementia front, here’s yet another feature from the Guardian about music and dementia. 

An opportunity for a fully-funded PhD scholarship studying the effects of music making on the health and well-being of young disadvantaged people. Click on the crumhorn above, or link below, for details.

Last week I read a small book by Tom Lubbock who was the arts critic for the Independent and who died last year. It’s a book about his dying and as such, is a wonderful account of what it is to be confronted by your mortality and is neither mawkish or sentimental. What is particularly strong is his account of losing his own word-finding and word-making and how ultimately, for me, this makes the book beautifully considered and nigh-on poetic. He also makes me realise what a bloody wonderful thing the NHS is.